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Organization
OPTIMAL VITALITY
Active
Organization
OPTIMAL VITALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDI KRISTEN BOAN PSYD (OWNER)
(630) 649-2819
Entity
Organization
Contact information
Practice address
200 S FRONTAGE RD STE 324, BURR RIDGE, IL 60527-6953
(630) 360-1173
(331) 992-2358
Mailing address
200 S FRONTAGE RD STE 324, BURR RIDGE, IL 60527-6953
(630) 360-1173
(331) 299-2358
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
133N00000X
Nutritionist
—
—
2084P0005X
Neurodevelopmental Disabilities Physician
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
09/29/2023
Last updated
09/29/2023
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